Understanding Asherman’s Syndrome
Intrauterine Adhesions (Asherman’s Syndrome) before adhesiolysis. Surgeon Dr Sam Dobson
Asherman’s Syndrome refers to the formation of scar tissue (intrauterine adhesions) within the uterus, often following surgery or infection. This scarring can range from minimal to extensive, affecting menstrual flow, causing pelvic discomfort, and in some cases contributing to fertility challenges or recurrent miscarriage. Diagnosis is confirmed using a hysteroscopy.
What Is a Hysteroscopy with Adhesion Division?
A hysteroscopy is a minimally invasive procedure that allows your consultant to assess the inside of the uterus using a slender telescope-like camera (a hysteroscope).
Fine surgical instruments are guided through the hysteroscope to gently divide adhesions and restore the uterine cavity. Imaging support (X-ray or ultrasound) may be used for precision. Once this is achieved, the endometrium then needs to be encouraged to rapidly regrow over the scar tissue to prevent adhesions reforming.
Because adhesions can reform, your care may include:
- Hormonal therapy (oestrogen followed by progesterone) to support endometrial healing
- A temporary uterine device (coil or balloon stent) to keep the cavity open during recovery
- Letrozole or other tablets to increase your bodies own oestrogen production to encourage the lining of the womb to grow.
These options will be explained in detail before your procedure.
Preparing for Your Asherman’s Procedure
- Day Surgery: You’ll go home the same day. An admission letter will include fasting instructions and medication guidance.
- Pregnancy test: All female patients under 51 years of age are asked to provide a urine sample on the morning of your surgery.
- Anaesthesia: This procedure is typically performed under general anaesthetic. A trusted adult should accompany you home and stay with you for the first 8 hours.
- On the Day: You’ll be admitted on the day of your surgery and asked to attend the hospital at either 7am or later in the morning. The surgery itself takes around 30–45 minutes. Please bring a book or tablet in case of delays.
Healthy intrauterine cavity after treatment for Intrauterine Adhesions (Asherman’s Syndrome) Surgeon Dr Sam Dobson
Aftercare and Recovery from Asherman’s Surgery
What to Expect
- Bleeding: Light bleeding is normal for up to two weeks, heavier in the first 48 hours. Use sanitary pads—not tampons.
- Pain: You may feel cramping similar to period pain. Medication will be provided as needed.
- Fatigue: Feeling tired afterwards is expected.
Rare Risks
Though uncommon, it’s important to know signs of complications:
- Infection: Fever, chills, joint aches, or unpleasant discharge
- Excessive Bleeding: Large clots, heavy flow (4+ pads/hour), or bleeding that persists beyond 48 hours
- Uterine Perforation (rare): Severe pain, swelling, nausea, fever, or exhaustion
Medication and Hormonal Support during Asherman’s Surgery
Depending on surgical findings, your consultant may insert:
- A copper coil (normally removed after 4-6 weeks) or
- A uterine balloon stent (removed after 10-17 days). If you feel a fine tube at the vaginal opening, rest assured—it’s normal and secure.
- A barrier gel to prevent adhesion formation.
Antibiotics and Hormones after Ashermans Surgery
Whilst everyones care is unique, you may be advised to take additional medication after your procedure, such as:
- Azithromycin 250mg: 1 tablet daily for the duration that the balloon catheter is in (to prevent infection).
- Oestrogen 2mg: 2 tablets, twice daily for 28 days (oestrogen support)
- Aspirin 75mg: 1 daily for 28 days (to improve blood flow)
- Provera 10mg: 1 tablet daily for 7 days (taken during the final week of the Oestrogen tablets)
- Letrozole: Three tablets (7.5mg) oral days 2 to 6 of the menstrual cycle.
- Pentoxifylline or Sildenafil: to improve blood flow.
Breakthrough bleeding or watery discharge during this course is common and not a cause for concern. Please complete the full course.
Going Home: What to Avoid for 24 Hours
If you’ve had sedation or general anaesthetic, do not:
– Drive or operate machinery
– Drink alcohol
– Sign documents or return to work
Do:
– Rest but stay active
– Eat normally and stay well hydrated
– Take extra care around household appliances
Follow-Up after Asherman’s Surgery
Follow up is individualised, based on your needs and situation, and will be discussed with you following your surgery.
If you have a balloon or coil you will be given a date to return to have this removed. If you do not, you may be asked to return for a saline scan in outpatient clinic, to break down and ensure there are no early adhesions forming. Occasionally a second look hysteroscopy may be required.
Important note
Every individual’s experience with Asherman’s Syndrome is unique. This leaflet offers general guidance, but it does not replace personalised medical advice. Choosing a surgeon with specific expertise in treating Asherman’s Syndrome is essential, as the success of treatment often depends on both skill and experience.
If you have any questions or would like to arrange an initial consultation with Dr Sam Dobson, please contact his secretary, Mandy Banbury, using the details below.
Mandy Banbury:
- Tel: 0115 966 2111 (Tues/ Wed/ Thurs)
- Email: mandy.banbury@circlehealthgroup.co.uk (Mon-Fri)
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